227 Sawgrass Drive Lot 714. -a
t/ DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax # (336)753-1680
OPERATION PERMIT
Account #: 990005710 Tax,PIWEH #: 5871-25-2458-1-ot#714
Billed To: D.R. Horton, Inc Subdi.Vision-lnfol Saddlebrook at Oak Valley 14:'Lot # 71y
Reference Name: Ben Lunnen . ,! : ,'�; Location/Address: Saddlebrook-27006 . .
Proposed Facility: Residence :':,., :Property Size: ' 35,081 Sq. ft
ATC Number: 5794 i's4
**NOTE** The issuance of this Operation Permit shall indicate the system described on the ATC has been installed
in compliance with Article 11 of G.S. Chapter 130A, Section.1900 "Sewage Treatment and Disposal Systems,"
but shall in NO WAY be taken as a'guarantee that the system will function satisfactorily for any given period of
time. .
System Type: 4ff S.T. Manufacturer cfG Tank Date_ZVr Tank Size IWO
Pump Tank Size n C n
System Installed By: i Qfel, /V( �dl�C E.H. Specialiat:An OA JA 40d ate:
GPS Coordinate:
b' 6
01
,U .0111*
1A
1 �
t� Cyt
DCHD 11/06 (Revised) '%u
l•I-g-bt
•. DAVIE COUNTY ENVIRONMENTAL HEALTH
P.O. Box 848/210 Hospital Street
Mocksville, NC 27028
(336)753-6780/Fax # (336)753-1680
AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION
Account #: 990005710 Tax PIN/EH #:,5871-25-2458-Lot#714
Billed To: D.R. Horton, Inc " Sul 6siiuision lnfoi :. Saddlebrook at Oak Valley 141_ot # 714.4
Reference Name: Beri Lunnen . :: LocallonlAddress: Saddlebrook-27006
Proposed Facility:. Residence " Prbpertysize: 35,081 Sq. f ; :
Site Type:,ft�iew ❑Repair'DExpansion
ATC Number: 5794 ""
**NOTE** This Authorization to Construct (ATC) MUST BE ISSUED by the Davie County Environmental
Health Section prior to issuance of any building permit(s), (in compliance with Article 11 of G.S. Chapter 130A
Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS AUTHORIZATION TO
CONSTRUCT IS VALID FOR A PERIOD OF FIVE YEARS. This ATC is subject to revocation if site plans, plat
on the intended use chance. ;i
i
Residential Specifications: # Bedrooms # BathroomsZ '� # People_ Basement❑ Basement plumbingO
Non -Residential Specifications: Facility Type ' # People_ # Seats_
Square Footage(or Dimensions of Facility)
Lot Size
System Specifications:
Site
Type of Water Supply: ❑County/City D Well ❑Community Well
Design Wastewater Flow (GPD) %Q TankS.ize](a GAL. Pump Tank�[) GAL.
8:30 —
Section for final inspection of mis,system netween
Environmental Health Spe
DCHD 11/06 (Revised)
4I IV
APPLICATION FOR SITE EVALUATION/IMPROVEMENT PERMIT & ATC k
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Application For. D Site EvaluationHmprovement Permit .0 Authorization To Construct(ATC) *oth
. Type of Applica ion: ANew System DRepair to Existing System O Expansion/Modification of Existing System or Facility
**'IMPORTANT"** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL OF THE REQUIRED
INFORMATTON IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions.
APPLICANT INFORMATION
- Name to be Billed D P , � Gt � Contact Person L t,
iP
Billing AddressHome Phone
CiTy/State2lP Q usiness Phone0 1, U IP v %a%
Name on Permit/ATC if Different than Above JL- 0.S l.l.h s� -
Mailing Address - City/State/Zip -
PROPERTY INFORMATION *Date House/Facility Comers Flagged
NOTE: A survey plat or site plan must accompany this application Included: &-Site Plain OPlat(to scale) -
(Permit is vali4 for 60 months with site plan, no xprmtion w th complete plat.) -
Owner's Name n c n��,� _ - Phone Number
Owner's Address � CiTy/State/Zip
Property Address U - City -
Lot Size 6,3, Ud I S ax P # �4
SubdivisionN e'ifanpidalil _ �JL Section/Lo
t#' -
Direc' ns To Ate: �uJJ ttii 1 d „e
R
If the ansvf& to my of the followi nations i es", supporting UccmanteDon must belattache .
Are there any existing wastewater systems on the site? Dyes o
Does the site containjurisdictional wetlands? DYes no ��VArrB tt '
Are theremy y easements or right-of-ways on the site? DYesNoeS.L�L.
Is the site subject to approval by another public agency? Oyes o -
W01 wastewater other than domestic sewage be generated? Dyes o
IF RESIDENCE FILL OUT THE BOX BELOW
#People #Bedrooms #Bathro ms Garden Tub/Whirlpool es ONo
Basement: DYes 27o Basement Plumbing: DYes 0360 - -
IF NON -RESIDENCE FILL OUT THE BOX BELOW A
- Type ofFacilityBusiness Total Square Footag ofBuiI& " ' WPeople
# Sinks # Commodes # Showers # Urinals
Estimated Water Usage (gallons per day) _ (Attach documentation of similar facility water Consumption) -
FOODSERVICE ONLY: # Seats -
Type system requested)(lConventional DAempted 01movative DAltemative DOther -
Water Supply Type:,County/City Water DNewWell OExisting Well 11 Community Well -
Do you anticipate additions or expansions of the facility this system is intended to serve? 0 Yes ()io
. If yes, what type?
This is to certify that the information provided on this application is true and correct to the best of my knowledge. I understand
that my permits) or ATC(s) issued hereafter we subject to suspension or revocation if the site is altered, the intended user
changes, or if the information submitted in this application is falsified or changed I hereby grant right of entry to the Authorized
Representative of the Davie County Health Department to conduct necessary inspections to determine compliance with applicable
laws d riles. 67understa a(I am responsible for the proper identification and labeling of property lines and comers and -
Ioca nand fla J r in i hour cility location, proposed well location and the location of any other amenities.
Pr a er's or owner's legs repre rntative signature Site Revisit Charge
/I •• Date(s):
l.(a Client Notification Date: -
EHS. .
Sign given DYes DNo' - Account #
Revised 11/06. Invoice # -
CC# 33q301
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APPLICATION FOR r;ITE EVALUATION/IMP ROVEMENT PERMIT & ATC
Davie County Health Department
Environmental Health Section
P.O. Bos 948/210 Hospital Street
Mocksvllle, NC 27028
(336)751-8760/ Ras (336)7.`1-8786
Application For. O Site EveluatiowbIFY.:nvement Permit 0 Authorial on To Construct(ATC) n Both
***IMPORTANT'** THIS APPLICATION CANNOT BE PROCESSED UfILESS ALL OF THE REQUIRED
INFORMATION IS PROVIDED. Recrul hell.'FORMATIONBULLET:Yfo[iaswctions.
NametobeBilled vqt� Rlla J ar+o a:�-. wr:rac.•"°�••� .- -
Billing Address Za limine Phone —
C1ty/State/ZiP10 Business Phone—�, 2^ DO
Name on PemdUATC if Different than Above _ ._
or Site plan must accompany mm 31313......,.
d for 60 months .vith site plan, no expiration with complete plat-)
Subdivision Name-
Dvections To Site:
if the =war to any of the following questions is "Yes", supporting durance' allOU Maar ee aL.I.-
Arethemanyexistingwastcwda systems on the site? DYes
Does We site contain jurisdictional wetlands? OYss o
Ara there any easements or igbr af--ways on the site? OY<s E]No
Is the site subject to approval by another public agency? DYes ONo
Will wastewater other than domestic sewage be generated? DY:a DNo
Dyes
IF NON -RESIDENCE FILL OLT THE BOX BELOW
Type of Facility/Business Total Square Footage of Building_ # People
# Sinks # Commodes # Showers _,_ # Urinals
Estimated Water Usage (gallons par day) (Attach documentation of siudlat facility water consumption)
FOODSERVICE ONLY: ASealL
Type systemrequeacd,.�g onventiood OAccepted Dlnnovadve DAltcmative nothes _
Water Supply Type: Vcounty/City Rater D New Well OWsting Well 0 Community Well
Do you anticipate additions or expvm.009 of the facility this system is intended to serve? D Yes 0<1
If yes, what type?
This is to at* that the information iimvided on this application is nue end correct to the best of my knowledge. l understand that
any permit(s) or ATC(s) issued hcreafv are subject to suspension orrevoc *tion if the site is altered the intended use changes, or if
the information submitted in this application is falsified or changed l undt stand that lam responsible for all charges incurred
from this application. I hereby grant right of entry to the AuthotizedRoph aenmtive of the Davie Countyhealth Deparuncutto
conduct necessary tions eJp mane cora Bance with applicable Inns and rude' on the abrwe described property located in
Devic Co.ty end owned byf11�,�'p
rjlt1Itr (vv+�/(� o Mr. 4�•Ll✓�_Ua{('�G1ruw'/ t a-jast�ft �'-�'.i•
Sign given DYcs ONO Account# -1 I Vt/L
Revised 2106 Invoice # —NO
APA 6 2006 D
ot
6 Iq 106
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gj
3 S F] . 61,1n,39
30,894 Sq. Ft.
>
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33,426 Sq.
Ft.
.01
I
P`
Lse Vviv-ell
St. Andrews Golf Villas
Seeflon 98. pti(jon 11, Section 2
Plot Book 8, Page 21 jIti
, rrq,
W)
,54,WiG Sq. rt. 35,496 Sq. Ft.
148' 145* 142'
.... .....
...................
227T
C)
141' 22i
1 5)
q. Ft.
28' 30,08E3 Sq.F t. 30,080 Sq. Ft.
10 270
peter
C)
0 �) , N - I
33,(69 Sq. F t. L7
Kassel
n Kassel
Igo 3(),150 Sq Ft
377
18
30,60 30 60 Sq Ft
,a
30,074 Sc'. Ft
/Cpl
rn
owJ
30,;37 S Ft
all)
50'
7626 /de Public
11917t Of QY)
,A - i t I
40,0
oil
227'
30,078 Sq. Ft.
I 227
30,078 Sq. Ft.
30,040 Sq. Ft.
7
441X0,
0n.51,107 Sq. Ft.
Z%J,
DAVIE COUNTY HEALTH DEPARTMENT
Environmental Health Section
Soil/Site Evaluation
APPLICANT INFORMATION PROPERTY INFORMATION
Account #: 990003765 Tax PIN/EH #: 5871-25-2458.09
Billed To: Oak Valley Associates Limited Partne Subdivision Info: Sawgrass Lot # 09
Reference Name: So Davis Location/Address: Beauchamp Rd-2700
Proposed Facility: Residence Property Size: see map Date Evaluated: q 11110c,
Water Supply: On-Site Well Community Public
Evaluation By: Auger Boring Pit Cut
I O�
FACTORS 1 2. 3 46 7 ,
Landsca a sition : L'
Slo e%
a
HORIZON I DEPTH O—
Texture rou
Fr
Consistence
Structure 3
Mineralogy�-
HORIZON II DEPTH
Texture group C_ +_4 0L+ C
Consistence
Structure
Mineralogya
HORIZON IH DEPTH
Texture group .S;L
Consistence
Structure SB
,..,.Mineralogy
HORIZON IV DEPTH
Texture group_
Consistence
Structure
Mineralogy
SOIL"WETNESS
RESTRICTIVE HORIZON.
SAPROLITE
CLASSIFICATION
LONG-TERM ACCEPTANCE RATE I 4N
SITE CLASSIFICATION: - • EVALUATION BY:
LONG-TERM ACCEPTANCE RATE OTHER(S) PRESENT:
REMARKS:.
LEGEND.
-
Landscape Position -
'
I CC Concave slope'houldCV - Convex slopelope , FS -Foot slope N -Nose slope
T - Terrace FP - Flood plain H - Head slope
Texture
Silt LSLoamy sand _ Sandy loam ,: L - Loam SI - Silt
SICL
y clay! loam SIL- Silt loam ' CL - Clay loam SCL -Sandy clay loam
SC - Sandy Clay' :.. SIC'- Silty clay .,:.. C - Clay
CONSISTENCE
Very VE - Very firm . EFI .- Extremely fora
VFR - Ve friable 'FR-Friable Fnable FI -Firm , ,
NS - Non sticky SS - Slightly sticky S -Sticky' VS -Very Sticky
NP - Nonplastic SP - Slightly plastic P - Plastic VP - Very plastic
SC - Single grain M'- Massive CR - Crumb GR -Granular' ABK - Angular blocky, -
SBK - Subangular blocky PL - Platy PR - Prismatic
Mirierulo,
1:1, 2:1, Mixed
•
;_Horizon depth'-' In inches
Depth of fill - In inches
Restrictive horizon - Thickness and inches from land surf
ace '.
Saprolite - S(suitable), U(unsuitable)
-Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chrorna 2 or less.
:Classification - S(suitable), PS(provisionally suitable), U(unsuitable)
LTAR - Long-tern acceptance rate - gal/day/ft2 DCHD 05105 (Revised)
Davk County ]
May 1, 2006
Oak Valley Associates, Ltd. Partnership
Attn: Bo Davis
3401 Healy Drive
Winston-Salem, NC 27103 p
Re: SAWGRASS Proposed Subdivision/ Lot #
Caudle Tract / Beauchamp Road
Tax PIN# 5871252458
Dear Client(s):
As requested, a representative from this office visited the above site April 11, 12, 18,
2006 to perform site evaluations. Based on the information provided on the Application for Site
Evaluation and after the evaluation was completed, the site was found to be provisionally
suitable for the installation of an on-site sewage disposal system.
This Improvement Permit DOES NOT authorize the construction of a wastewater system.
An Authorization To Construct a wastewater system must be obtained from this office prior to
the construction/installation of a wastewater system or the issuance of a building permit(in
compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems). This Improvement
Permit is subject to revocation if site plans or the intended use change.
Improvement Permit
System To Serve: as;sl Wastewater Design Flow:_
System Type: 0Conventional 2<ccepted 01nnovative OAlternative OOther
System Location: } Valid:Yeazs ❑No Expiration
Site Modifications/Permit Conditions:
rjkF- tA (5'
nduo a ialis Date
ps-i.p.letter 2/06